Clinical features of childhood refractory cytopenia

AN Wen-Bin; ZHANG Pei-Hong; REN Yuan-Yuan; GUO Ye; WANG Shu-Chun; CHEN Xiao-Juan; YANG Wen-Yu; CHANG Li-Xian; ZHU Xiao-Fan

doi:10.7499/j.issn.1008-8830.2015.01.004

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Chinese Journal of Contemporary Pediatrics ›› 2015, Vol. 17 ›› Issue (1) : 15-21. DOI: 10.7499/j.issn.1008-8830.2015.01.004

CLINICAL RESEARCH

Clinical features of childhood refractory cytopenia

AN Wen-Bin¹, ZHANG Pei-Hong², REN Yuan-Yuan¹, GUO Ye¹, WANG Shu-Chun¹, CHEN Xiao-Juan¹, YANG Wen-Yu¹, CHANG Li-Xian¹, ZHU Xiao-Fan¹

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Abstract

Objective To study the clinical features of patients with refractory cytopenia of childhood (RCC). Methods The clinical data of 1 420 children (0-14 years old) with an initial diagnosis of non-severe aplastic anemia between January 1990 and June 2013 were retrospectively analyzed. Bone marrow cell morphology and histopathology were re-evaluated, and the patients were re-classified using the criteria proposed in the 2008 edition of the World Health Organization classification of RCC in hematopoietic and lymphoid tumor tissues. The clinical outcomes were followed up every 3-6 months. Results Among all the 1 420 cases, 152 (10.7%) were reassessed as RCC. Patients with RCC had a lower level of hemoglobin and a higher percentage of fetal hemoglobin than those with non-severe aplastic anemia. Of the patients with RCC, 21.5% showed abnormal karyotypes at diagnosis. The median follow-up period for all patients was 36 months (ranging from 1 to 283 months). The rates of complete response, partial response, and no response to cyclosporine and androgen treatment in RCC patients were 19.0%, 26.7%, and 54.3%, respectively. The 5- and 10-year prospective overall survival rates of RCC patients were 87.9% and 72.4%, respectively. The 5- and 10-year prospective clonal evolution rates were 15.3% and 20.0%, respectively. The 2-year prospective incidence of newly diagnosed karyotype abnormality after the initial diagnosis was 3.6%. The 5- and 10-year prospective leukemia transformation rates were 10.0% and 20.0%, respectively. Conclusions RCC shows clinical features similar to adult myelodysplastic syndrome. Children with RCC have a poor prognosis, an increased risk of transformation to leukemia, and a low response rate to cyclosporine treatment.

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Refractory cytopenia / Clinical feature / Prognosis / Child

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AN Wen-Bin, ZHANG Pei-Hong, REN Yuan-Yuan, GUO Ye, WANG Shu-Chun, CHEN Xiao-Juan, YANG Wen-Yu, CHANG Li-Xian, ZHU Xiao-Fan. Clinical features of childhood refractory cytopenia[J]. Chinese Journal of Contemporary Pediatrics. 2015, 17(1): 15-21 https://doi.org/10.7499/j.issn.1008-8830.2015.01.004

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